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Leydig cell tumors (LCTs) are rare testicular neoplasms that account for a small proportion of testicular tumors and are often diagnosed incidentally or on investigation of infertility or hormonal symptoms. Despite their generally benign behaviour, a small percentage may have malignant potential, which poses a diagnostic and therapeutic challenge due to the lack of standardizedguidelines.

We retrospectively analysed four casesof histologically confirmed LCTs diagnosed and treated at a single institution between 2000 and 2024. Clinical, biochemical, radiologic, surgical, and pathologic data were collected and analysed.

Patients presented with a variety of clinical histories, including testicular swelling, infertility, or incidental findings. Tumor size ranged from 1.8 to 3.5 cm. All patients underwent radical inguinal orchiectomy, and histology confirmed benign LCTs without high-risk features such as necrosis, mitotic activity, or vascular invasion. Hormonal profiles and imaging were key to the diagnostic process, although findings sometimes mimicked germ cell tumors. Adjuvant therapy was not required, and all patients remained disease-free at follow-up.

This case series highlights the heterogeneity of LCT presentations and emphasizes the importance of accurate diagnosis, individualized treatment, and multidisciplinary management. Standardized protocols, greater awareness and timely imaging are essential to avoid overtreatment and improve outcomes in LCT patients.